Our team of experts bring a wide range of skills and experience to meet our clients’ needs.
We used our clinical strategy and redesign expertise to support the Healthy Wirral Programme. We supported the development of a new model of care for Ophthalmology services as part of the Planned Care programme. The main benefit of this work is to support both adults and children to have a healthy start in life.

The Challenge

In November 2019, the Chairs and Chief Executive Officers (CEOs) of the Wirral healthcare system wanted to refresh the Healthy Wirral programme. They accepted a series of recommendations following a review of the existing portfolio. This included setting up five priority programmes:

• Medicines Optimisation
• Planned Care
• Unscheduled Care
• Out of Hospital Care
• Back Office

Healthy Wirral commissioned the NHS Transformation Unit (TU) to support the initial workstreams within Planned Care. This included developing a Healthy Wirral approach to service reviews. Healthy Wirral agreed to review Ophthalmology first under the Healthy Wirral Planned Care programme.
Ophthalmology services have the highest number of outpatient attendances in England and face national and local challenges. Services are not meeting the current demand and the number of follow up appointments are growing. Wirral has additional local challenges, including an ageing population and variation in care across the region.

Our Approach

We followed our clinical redesign methodology to design a clinical model of care for the population of Wirral.

We built on previous work led by Wirral CCG to engage with key stakeholders, including:

• Current and prospective service providers
• GPs
• NHS England
• Public Health
• Other healthcare professionals
• Patients

To produce the model of care, we developed a co-dependency framework and clinical standards that aim to deliver improved patient outcomes. We also refreshed the governance arrangements to support cross-system assurance and decision making.

The Outcome

During the first workshop, stakeholders agreed high level principles for the model of care seen in the details below:

• Our service is designed to deliver the best possible outcomes for the population of Wirral
• Our service is future proofed to deal with changing demand and population health needs
• Patients are provided with care in the most appropriate setting, by the right person
• We will work collaboratively with integrated care partners, working across different sites where appropriate
• Patients have equality in access to their care and receive the same level of quality regardless of where they access the service
• We develop a seamless pathway across Ophthalmology services

From this, we developed the model of care with 6 key components:

• Shared decision making
  Personalised care with an emphasis on shared decision-making and patient self-management.
• Rethinking referrals
  Ensuring appropriate referrals and improving quality of in-hospital referrals.
• People training and education
  Full utilisation of the knowledge and skills of the optical workforce as primary health care providers / first contract practioners ans secondary care workforce.
• Whole system communication and collaboration
  An integrated approach to delivering care with improved communication. Working together to reduce the incidence of ocular and ophthalmic clinical leadership and governance.
• Technological digital and business intelligence
  Integrating clinical software infirmation and digital solutions within hospital patient administration systems to improve communication and decision making.
• Redesiging outpatients
  Virtual diagnostic pathways, management decisions based on clinical data and images collected in the community, optical practices, or diagnostic hubs.

Finally, we outlined the next steps of this work, including:

• Financial analysis and options appraisal
• Public engagement and formal consultation
• Impact assessment
• Decision making
• Implementation plans and checklists